Consumer Edition

February 2005 | Vol. 6, No. 1
© 2005 American Massage Therapy Association®
All rights reserved.

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Whiplash is an all too common condition people experience after fender-bender accidents. In fact, the American Academy of Orthopaedic Surgeons estimates about 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. Most people recover quickly from whiplash, but some go on to experience what is known as chronic whiplash syndrome. Check out Dr. Leo Stouder’s article, “Preventing Chronic Whiplash Syndrome With Massage,” to learn how massage therapy can help ease the suffering.

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Preventing Chronic Whiplash Syndrome With Massage

By Leo B. Stouder

Mary has been suffering with chronic whiplash syndrome ever since she was in a car accident several years ago. The car that hit her was going slowly, and she was stopped. There was no damage to her car, but she was treated with medication and wore a soft collar for many weeks after the accident. She eventually needed stronger medication to dull the pain. She hasn’t worked since her accident, and she is a casualty of chronic whiplash syndrome (CWS).

The American Academy of Orthopaedic Surgeons estimates about 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. While most recover quickly, a small number—like Mary—develop chronic conditions that result in severe pain and sometimes even disability.

A major concern in acute whiplash injuries is the fact that these cases will become chronic. The body was not designed to withstand the kind of injury while seated, and while car restraints reduce fractures of the spine, they don’t offer much hope for soft tissue injuries.

LifeART/MEDICLIP image copyright 1997 Lippincott Williams & Wilkins. All rights reserved. This illustration shows the muscles that are often affected in rear-end and/or front-end collisions.

Time is of the essence in whiplash cases. The longer the patients go without proper treatment, the more they run the risk of chronic pain. The amount of damage to the vehicle does not equate to the level of injury that the body may sustain. Remember, the force of the accident has to be absorbed somewhere—if it does not go to the vehicle, then the force will go into the passengers.

What Is Whiplash?

The National Institute of Neurological Disorders and Stroke defines whiplash as a soft tissue injury to the neck. It is characterized by a collection of symptoms that occur following damage to the neck. The symptoms can occur right after the injury, or may be delayed for several days. Symptoms can range from neck stiffness, headaches and dizziness to abnormal sensations such as burning, shoulder pain or back pain. Some people even experience memory loss, concentration impairment or sleep disturbances.

But some medical professionals feel that the root cause of CWS is psychological. The reasoning is that an acute whiplash patient restricts movement due to fear that the pain will be worse. As the theory goes, this restriction of movement causes a chronic pain situation.

I believe the primary reason for CWS is not in the patient’s head—it is in the soft tissue of the neck. The patient restricts movement because of the pain. Lessen the pain by increasing the function of the neck, and you will have the prescription to prevent CWS.

How Massage Can Help

Massage therapy can help prevent CWS.  When the massage therapist works the appropriate muscles, neck pain decreases and range of motion increases.

LifeART/MEDICLIP image copyright 1997 Lippincott Williams & Wilkins. All rights reserved. The pectoralis minor muscles, which lie deep in the front chest, are often strained in an accident when the body is thrust forward.

First, the massage therapist will take a good history of the accident, emphasizing how the patient was hit. Was it a rear-end or a front-end collision?  The head and neck should be evaluated for injury by range of motion and posture analysis. Then, the muscles mentioned below should be checked for spasm and other dysfunctions.

In classic whiplash, the neck goes through one of two mechanisms of injury—from a front-end collision or from a rear-end collision. Front-end collisions thrust the head forward and whip backward. The neck extensors (splenius capitius, semisplenius capitius) and upper trapezius are often injured in a front-end collision because they become overstretched.

In a rear-end collision, the head is thrust backward and then whipped forward. The sternocleidomastoid muscle, along with the scalenes, are the important muscles that are involved in this scenario.

The rear-end collision muscles and the front-end collision muscles are usually found to have sustained a micro-avulsion injury, where the muscle tears away from its attachment on the bone due to the trauma that is sustained from the whiplash motion of the neck. A muscle with a micro-avulsion injury will not function properly, which means the muscle will not be able to support the head and neck as it should. Massage therapy, by working generally on the muscles, will assist the muscle by increasing its blood supply. In addition, a technique that focuses on the specific muscle injured can be applied to the attachment sites of the muscle to facilitate the bonding of the muscle back to its attachment.

A pair of muscles often overlooked is the pectoralis minor muscles. Special attention should be given to these muscles, which lie deep in the front chest. Often these are the muscles strained when the body goes forward, and the restraint of the seat belt prevents the full movement forward. It is often found that the left pectoralis minor is affected more in drivers who were wearing their seat belt.  Passengers who wore a seat belt in the front seat will show trauma to the right pectoralis minor. Note that our seat belts only go over one shoulder, which is the area of trauma intensity. Race car drivers, in contrast, are in a harness seat belt that holds both shoulders secure. This actually restricts soft tissue injury.

Massage therapy can make a major difference in acute whiplash by decreasing the patient’s suffering initially. With this relief, the massage therapist will help clients like Mary diminish the possibility of suffering from chronic whiplash syndrome.

Dr. Leo B. Stouder, D.C. (aka, Dr. Anatomy) teaches Applied Anatomy Seminars Send comments to: DrAnatomy@Bellsouth.net and visit www.DrAnatomy.com.